Food Allergies…What You Need to Know

Common Food Allergies

Food allergy is common in infant and young children. It can be frustrating for parents - colicky infants, vomiting, constipation and not tolerating formula or sometimes even breast milk.

And for the child, the impact is even more so - failure to thrive is common, which may lead to developmental delay as poor nutrient intake impairs achievement of developmental milestones. Thus, it is important for parents and pediatrician to diagnose food allergy in a timely manner to avoid long-term detrimental outcomes.

The good news is most of these allergies in young children will resolve on its own by 4-5 years of age.

Food allergies and intolerances is the result of "leaky gut". When the gut lining is damaged by harmful micro flora, drugs, chemicals and toxins in food, food do not get the chance to be digested properly before they get absorbed through this damaged wall. This causes the immune system to react to them.

This is why many people have difficulty trying to identify which foods they react to, because damaged intestinal wall is letting anything pass through. So any foods may cause an immediate or a delayed reaction.

An immediate reaction happens within minutes or hours of ingestion. Whereas, a delayed reaction may take up to a day, a few days or even a couple of weeks later. As these reactions overlap with each other, you can never be sure what exactly you are reacting to on any given day.

This is also the reason why food allergy testing are notoriously unreliable.

Hidden food allergy or intolerances are also common and difficult to identify. Our common perception of food allergy is someone who is allergic to seafood, and ate something with shrimp, and within minutes reacted with full body hives, facial swelling, itching mouth and throat, etc.

However, these are not what we're seeing in children with hidden allergies or intolerances. Reactions to food intolerance are delayed and more subtle. Therefore, they are frequently ignored or dismissed. Food intolerance and food allergy shares many similar signs and symptoms. However, they are very different physiologically.


Food allergy triggers an immediate immune response, usually involving the immunoglobulin E (IgE). IgE-mediated response activates a cascade of systemic reactions, involving multiple organ systems. That is why this is the more severe form food intolerance. Fatal peanut allergy falls into this category. Usually a tiny amount of the offending food can cause an immediate and severe reaction, and may sometimes lead to anaphylactic shock, which is life-threatening emergency.

An anaphylaxis is characterized by systemic responses, such as difficulty breathing due to swelling of airway, hives along with itching, flushed or pale skin, weak and rapid pulse, dangerously low blood pressure, nausea/vomiting or diarrhea, dizziness or fainting.

An anaphylactic event requires emergent medical treatment, and delay of treatment may result in death. People with severe food allergies are usually prescribed and "epi" epinephrine pen that they carry around in case they consume or come in contact with their allergen by accident.

Food intolerance, on the other hand, does not involve the immune system, and reaction also comes on a lot slower - usually after two hours of ingestion of food, and sometimes up to 48 hours with more subtle presentation. Unlike food allergy, an individual usually is able to tolerate a small amount of the offending foods without much adverse effect.

Symptoms of food intolerance are generally less serious, less obvious and appear very subtly and slowly. That's why the trouble food is seldom identified. Some common signs and symptoms may include nausea, vomiting, abdominal cramps, constipation, diarrhea, asthma, eczema (atopic dermatitis), etc. Food intolerances may also result in behavioral symptoms frequently seen in ADHD and autism.

Unlike food allergy, food intolerances are not detected by RAST test or skin prick tests, as both these test for IgE circulating in the blood. Reactions in food intolerance are not IgE-mediated. It may be the result of activation of IgG antibodies or other causes.

Once the offending food is identified, it should be avoided completely, especially the reaction is an IgE-mediated reaction. Food allergies are common in the first years of life. With every repeated exposure to the offending food, the immune system becomes better in attacking that allergen, which means the response will become more and more intense with each repeated exposure. Children usually outgrow their allergies by 4 or 5 years of age. However, repeat exposure may prevent or delay the time to outgrow the allergy.

Related post: Elimination Diet

Non-Dairy Calcium Food Sources


When it comes to calcium, the first thing that comes to most people’s mind is milk.

Thanks to the heavy marketing of the dairy industry, the world has been brainwashed to believe that cow’s milk or dairy products are the only sources of calcium and the best for bone development and growth.

If you think about it, the biggest sources of calcium is bone, which is the reason why we’re so concern about calcium intake, right.
So it makes sense that we should be eating animal bones to get our calcium. After all, it is the exact source of calcium that our body needed.

I’m just appalled that after all these years, no one has ever questioned the justification of having dairy product as its own group on Four Food Groups, Food Guide Pyramid, Food Step Pyramid and the most recent MyPlate.

Anyway, my point is milk and all dairy products are just over-rated.

Contrary to popular belief and what the dairy industry wants you to believe, you don’t need to drink milk or eat cheese and yogurt to get your calcium for your bone health.

Many cultures in the world does not consume dairy, and if they do, dairy is just a small part of their diet.

And for some other people, their body just does not get along with milk.

Since we’re all so concern about our calcium intake, so how much calcium do we need?

Current calcium recommendation by age:

Infant 0-6 mos – 200mg/d; 6-12 mos – 260mg/d.

Children 1-3 yo – 700mg/d; 4-8yo – 1,000mg/d; 9-18yo 1,300mg/d.

Adult 19-50yo – 1,000mg/d; more if female older than 50 and male older than 70.



One cup of cow’s milk has about 296 mg.

Below is a list of non-dairy sources of calcium that comes close to the calcium content of cow’s milk:

Sesame Seeds A quarter cup of sesame seeds has 351 mg calcium.

Spinach A cup of boiled spinach has 245 mg.

Collard Greens A cup of boiled collard greens has 266 mg.

Canned Salmon 3oz has 181mg.

Blackstrap Molasses One tablespoon has about 137 mg.

Kelp One cup of raw kelp has 136 mg.

Tahini Two tablespoons of raw tahini (sesame seed butter) have 126 mg.

Broccoli Two cups of boiled broccoli have 124 mg.

Swiss Chard One cup of boiled chard has 102 mg.

Kale One cup of boiled kale has 94 mg.

Brazil Nuts Two ounces of Brazil nuts (12 nuts) have 90 mg.

Celery Two cups of raw celery have 81 mg.

Almonds One ounce of almonds (23 nuts) has 75 mg.

Papaya One medium papaya has 73 mg.

Flax Seeds Two tablespoons of flax seeds have 52 mg.

Oranges One medium orange has 52 mg.

Nutrition Tips: Mix and match any of the ingredients listed above and you’ll have an calcium- and antioxidant-rich salad.

The goal is to eat a healthy balanced diet with a variety of fruits and vegetables of the rainbow colors, various types of beans, nuts and seeds. And animal proteins are used only for flavors.

Dairy-Free Diet for Milk Allergy


The dairy-free diet is an elimination diet that eliminates all dairy products, such as milk, cheese, yogurt and all ingredients derived from milk.

It is intended for someone who is allergic or sensitive to cow’s milk.

The goal is to eliminate allergens from milk that trigger allergic reaction.

To successfully implement the dairy-free diet and achieve the best results, one has be meticulous with nutrition label reading, and savvy in the kitchen.

There’ll be new behaviors and habits, and new recipes to embrace.

Because milk is such a cheap commodity (as the industry is heavily subsidized by government’s grant), milk and its derivatives can be found in almost anything food products as additives. So you might not recognize these hidden milk ingredients on plain sight.

Fortunately, the US laws requires all FDA-regulated manufactured food products that contain a “major food allergen”, such as milk, wheat, egg, peanuts, tree nuts, fish, crustacean shellfish and soy, as ingredients to list that allergen on the product label.

For tree nuts, fish and crustacean shellfish, the specific type of nut and fish must be identified.

The phrase "non-dairy" on a nutrition label indicates it does not contain butter, cream, or milk. However, this does not necessarily mean it does not contain other milk-derived ingredients.

The Kosher food label "pareve" or "parve" almost always indicates food is free of milk and milk products. A "D" on a food label next to the circled K or U indicates the presence of milk protein. These products should be avoided.

Processed meats, such as hot dogs, sausages, and luncheon meats, frequently contain milk or are processed on milk-containing lines.

Carefully read all food labels before purchasing and consuming any items. When in doubt, call the manufacturer to find out more.

Avoid foods that contain these ingredients:

Milk in all forms (derivative, dried, powdered, condensed, evaporated, goat’s, from other animals, lowfat, malted, milkfat, nonfat, skim, sour cream, yogurt, cream, cheese, buttermilk, Half and Half™ )
butter, butter fat, butter oil, butter acid, butter ester, ghee
casein, caseinates (ammonium, calcium, magnesium, potassium, sodium), casein hydrolysate
cheese, cottage cheese, curds
custard, pudding
hydrolysates (casein, milk protein, protein, whey, whey protein)
lactalbumin, lactalbumin phosphate, lactoferrin, lactoglobulin
rennet casein
sour cream
sour cream solids
whey (delactosed, demineralized, protein concentrate), whey protein hydrolysate

Other possible sources of milk or its derivatives:

artificial butter flavor
baked goods
brown sugar flavoring
caramel flavoring
high protein flour
lactic acid starter culture and other bacterial cultures
luncheon meats, hot dogs, sausages
natural flavoring

Many pediatricians and parents automatically raise concern about adequate calcium intake with a dairy-free diet, as milk is a very good source of calcium and other nutrients, as advertised by the Dairy Council.

And according to the various dietary guidelines over the past decades, milk and dairy products has always been represented as one group by itself.

There’s an over-emphasis on the importance of milk and dairy intake in our culture, in the American culture.

First of all, let me point out that many cultures in the world do not consume milk or dairy products on a daily basis. And people from these cultures thrive.

There are many non-dairy food that are rich in calcium.

Check out these non-dairy calcium food sources.

Second, let’s look at the nutrient profile of milk.

Milk Nutrient Content

The macronutrients in milk are fat, carbohydrates, and protein. Can you get any of these nutrients from other food in your diet?


The micronutrients in milk are mainly calcium, potassium, and vitamin B12. Can you get these nutrients from other foods?

Yes, too.

Can you replace cow’s milk with plant-based milk?

Yes. But here’s the caveat. Plant-based milk is not a compactible replacement. Most plant-based milk, such as soy, almond, or coconut milk, has significantly lower caloric and protein content.

Milk By the Number

So, if you’re going to replace cow’s milk with one of these plant-based milk, you need to be sure to increase protein and calorie intake from other food as well.

Another point to remember is that many infant and children who are allergic to cow’s milk are also sensitive to soy protein. About 60% to be exact. In these kids, replacing cow’s milk with soy milk will not solve the problem.

Constipation in Infants and Children

Constipation in Infants & Children

Constipation is a common problem in infants and children.

As a pediatric dietitian, I see this problem frequently and the cause is seldom because of lack of fiber or fluid.

Children in general does not require a lot of fiber. Their intestines are shorter, thus, shorter transit time. And we don’t want food to go through the intestine too quickly. Otherwise, the body would not have enough time to digest and absorb nutrients during the precious growth period.

Fluid intake or hydration is seldom an issue either. Most infant’s main diet is either breastmilk or formula, so hydration is not an issue. Same for toddlers, who usually consume 16-32oz whole milk along with couple ounces of diluted juice.

However, too much milk can be constipating for some children.

Let’s first define constipation

Constipation is usually defined as having infrequent bowel movements that are hard and painful. However, in children, it is less related to the frequency of pooping. But more the consistency of the poop.

Infants that strain or groan when they poop are not constipated if their stool is soft, even if they only have a bowel movement every two or three days. It is also important to remember that many breastfed infants only have a bowel movement once every week or two.

Parents frequently describe the poop of their constipated kids as “rabbit’s turds”, “hard pellets”, “pebbles”, “hard rock”, “golf ball”, etc.

What Causes Constipation?

Remember, constipation is not a condition itself. It is a sign or symptom that something else is wrong, such as an underlying medical condition, such as Hirschsprung's disease, cystic fibrosis, Celiac disease, spinal bifida, hypothyroidism, food allergy, etc.

Constipation is also often found in children with special needs, such as spina bifida, Down syndrome, mental retardation and cerebral palsy, and it can be a side effect of many medications and hypotonia.

Children with developmental delays that involve hypotonia or low muscle tone tend to have constipation. And this is due to weak musculature of the child. Hypotonia does not only affect skeletal muscles, but is affects smooth muscles in the inters tines as well.

Cow’s milk protein allergy is a common cause of constipation in infant and young children. Other signs to rule out that constipation is the result of cow’s milk allergy is projectile vomiting and bright red blood in stool.

There are many reason why an infant poops only once a week. Some breastfed children poop once a week. And there poop is normal yellow seedy poop and growing well. Then, I would say, that’s their normal.

If, on the other hand, an exclusively breastfed infant is pooping only once a week with normal yellow seeding stool, but not gaining weight or failure to thrive. Then, I would suspect inadequate intake from breastmilk.

Either the child is not latching properly or mom’s milk supply is being compromised.

Further investigation is needed.

Constipation is frustrating for both the child and the parents.

In pediatrics, we always say that children control their parents with 3 things: eat, sleep and poop. These are the three things that drive parents nut the most.

Treating Constipation in Infants and Children

Constipation, if not treated, can lead to a vicious cycle of constipation, not want to eat, then become more constipated, then not want to eat even more. Eventually vomiting, poor growth, and abdominal distention may result.

Like I said, I see constipated children frequently in my practice. I also see many children with constipation on medication, such as miralax. Almost every constipated child I see is on miralax, an osmotic laxative.

Now that you have better understanding of the cause of constipation, we’re going to talk about the treatment.

Constipation Treatment in Infants and Children

The treatment is for the cause of constipation. We’re not talking about giving a medication to “manage” the constipation. We’re going to “cure” constipation or make it disappear for good.

Medication should be save for the very severe case of constipation involving obstruction and causing other problems. Warning signs that may indicate a more serious condition causing your child to be constipated include poor appetite, vomiting, weight loss, poor weight gain, fever, abdominal distention or having a poor appetite.

It is important to note that infants that are exclusively breastfed rarely become constipated. Infrequent bowel movements do not mean constipation if your infant's stools are soft when he finally passes one. And, most importantly, your infant is growing nicely on the growth chart.

I’ve heard parents adding Karo syrup or other light or dark corn syrups to their infant's bottles of formula. I have never have any parents tried this. It just does not sound right. So I would not recommend Kara syrup or whatever other syrup in infants.

Infants’ digestive system is very delicate, you don’t want to put random things in it.

If you have an exclusively breastfed infant with hard pellet stools, projectile vomiting or blood in stool. I would suggest mom to first remove all dairy (cow’s milk, cheese, yogurt, etc) from her diet. If that doesn’t solve the problem, then remove soy products too.

If the infant is formula-fed with hard pellet stool, projectile vomiting or blood in stool. Change to either soy, or better yet, a semi-elemental formula, such as Alimentum or Nutramigen. If these do not work, and symptoms persist, then try elemental formula, such as Neonate Infant or Elecare Infant.

WIC will provide these formula with a physician prescription with a diagnosis of milk protein allergy.

Projectile vomiting in infants can also be the result of gastric reflux, tracheomalcia or pyloric stenosis.

But with blood in stool, cow’s milk allergy sits highly on the list.

In cases where it’s just simple constipation, there is no projectile vomiting or blood in stool, I usually suggest parents to give couple 2-3 ounces of diluted juice (apple, pear, white grape or prune) a day. This usually resolve the constipation.

For older children, it may be the amount of dairy product they consume. The most common dietary culprit I see with constipation is dairy products, such as milk or cheese.

I personally do not think dairy products is necessary. And that human babies consuming cow’s milk is just not natural. But the dairy industry has so much power over the dietary guidelines that dairy occupies one whole food group of its own instead of being part of the protein group.

Read more about dairy in “Got Milk or Not Milk”.

What if your child is constipated because he/she is intentionally hold their poop?

Having infrequent and large poop that are painful to pass is not fun. Did I mention painful too?

When this happens frequent enough, your child may start to associate pooping with pain, and he/she will try to hold his poop to avoid the pain.

This creates a viscous cycle, where bowel movements are painful, so he holds them in, causing his stools to be even larger and harder, which causes even more pain when it finally does pass.

To stop painful, large and hard poop is to not get constipated in the first place. If it is ruled out that milk allergy is to blame, then avoid dairy products at all cost.

If it’s Celiac disease, then eliminate gluten from the diet.

Anything else…dietary changes and behavioral modification will do.

Is there a special diet for constipation for children?

Yes and no…it depends on your child’s current diet.

The general recommendation is that everyone, including children 1 year old and older and all ages, should consume a well-balanced plant-based diet - 50% all fruits and vegetables, 25% whole grains and 25% protein (mostly from nuts, beans and seeds).

If youe child and your family is already eating plant-based, there is nothing to change.

But if your family’s diet consists of mostly processed and convenient food, there is a diet for you. And it’s the plant-based diet.

We all know the dietary association with constipation. And we know what food is constipating and what food is not.

But getting a toddler or even young children to eat a healthy diet is difficult, despite the colorful rainbow display of color from all fruits and vegetables. Not to mention if your child has been constipated for a while, there is likely no appetite and they’re probably picky too.

So good luck getting broccoli, kale or spinach in them. But at least decrease milk, yogurt and cheese, bananas, and other constipating foods.

Then, try these strategies to get more fruits and veggies in them.

Fruits and veggie smoothies. 1/4 green leafy vegetables, 3/4 fruits, 1-2 tablespoons of flaxseeds or chia seeds for extra fiber, 1 tablespoons of nuts for protein, then non-dairy milk for the liquid portion.
If they don’t want to drink it, freeze the smoothie into popsicles for snack.

2. Hide or blend fruits and veggies in food or dishes. Consult kid-friendly recipe books, such as Deceptively Delicious by Jessica Seinfield and Sneaky Chef by Missy Lapine. These are my favorites.

3. Simple kid-friendly fruits and vegetables recipes that your child can help make. This empowers them to make good choices on their own, with your setting the limits.

4. Power Pudding. The legendary grandma’s recipe for constipation.
Mix 1 cup unsweetened applesauce, 3/4 cup prune juice and 1 cup unprocessed wheat bran into a pudding form. Take 1 tablespoon each morning.

Power Pudding

5. Add flaxseed or chia seeds to stews, casseroles, smoothies, pudding, etc. They’re not only high in fiber, they’re also good sources of protein and omega-3 fatty acid for brain development.

How Much Fiber is Enough?

Don’t get overzealous with the fruits and vegetables.

Speaking of too much fruits. My daughter loves fruits and vegetables, even as a toddler. She loves watermelon and it’s watermelon season. She keep asking for watermelon, and I thought she would stop when she’s full, but I guess I was wrong.

You know how you can tell your child ate too much watermelon?

When watermelon was coming out of her wasu (literally).

Children’s fiber needs is a lot less than adults’. The daily recommendation is 5 grams of fiber plus their age in years each day. So a 4 year old should have 9 grams of fiber each day.
Because children’s have much lower needs of fiber than adults, you don’t have to intentionally give very high fiber food at each meal.
Just eating some fruits and vegetables throughout the day, should be enough.

Excessive fiber intake in children can result in malnutrition too. So moderation. Just enough to have a normal soft poop every day or other day.

Children with constipation as part of a medical condition, on the other hand, tends to need more fiber. Because of hypotonia, many children with development delays are less mobile, which also contribute to constipation.

In these children, stool softener or a fiber supplement, such as Metamucil or Citrucel or Benefiber, may be needed.

Behavioral Training

Once your child's stools have become soft and regular, it is important to encourage regular bowel movements. This can be accomplished with having your child sit on the toilet for about 10 minutes after meals once or twice a day. You can keep a diary or sticker chart of when he tries to have a bowel movement, then offer a reward for regular compliance.

With proper evaluation of the underlying cause and dietary intervention, your child should be able to have normal soft and pain-free poop.

In severe case of acute constipation, your child may need a 'clean out' or disimpaction before all these dietary and maintenance therapy can work.

Constipation CAN become a chronic condition if not treated properly. In addition to pain, constipation can lead to anal fissures or tears in the skin around the rectum, bleeding, hemorrhoids, rectal prolapse, and impaction. Encopresis is another complication of chronic constipation and can lead to involuntary stool leakage secondary to the impaction of large masses of stool.

In situations where constipation cannot be resolved with any common therapy, a referral to a Pediatric Gastroenterologist may be needed, especially if our child has any warning signs of a more serious condition or if he/she isn't improving with your current therapies.